Sunday, September 24, 2017

I found the answer to that today. It was an eventful weekend. It's been about 2 months since I've started my new job as a first time attending (more on this on another post!) but since then, it's been non-stop with the move from San Diego to Los Angeles, getting little C adjusted to her new school, starting a new job, studying for boards (which is next month!) and furnishing a new house! I have to say we got pretty lucky and everything is going fine with of course a few bumps in the road but that's expected.

My in laws, including my mother in law, father in law and two aunts came to visit for the weekend. It was a stressful but happy weekend! Moving on to the topic of this post, my brother in law (big C's brother) and his wife and I don't get along. The primary reason being that he doesn't like the fact that I'm a physician and how often I talk about it, which with him, is mainly limited to group emails and text messages amongst my husband's side of the family.

If you guys remember my story, I did not live with little C for the first 2.5 years of her life as she stayed with my parents in Irvine, an hour away form San Diego. Afterwards, I was a single mom with little C for 2 years while I did long distance with big C. During those times, we didn't have much time to visit his side of the family in northern California. I look back at these emails and I do realize I talk a lot about what I do, career wise, but often times, it was out of guilt and my way of explaining as to why I was so sorry that they aren't able to see their granddaughter that often.

Moving on, my brother in law and I had an argument today about the fact that he cancelled plans on us this weekend and he didn't offer an explanation. (Reason being--he just didn't feel the need to tell me.) But regardless, in this argument, he said that I needed to know my audience. The fact that his wife (stay at home mom) is at home with his daughter all the time with no help makes me inadequate to talk about my struggles as a working resident mom when I had help from my own mom. He said I was a "part time mother" for 2.5 years and that his wife is a "super mom" because she doesn't ever use a nanny or house cleaner. Wow. Those words really got to me. It took awhile to process. Little C is already almost 5. She's been with me over 2 years now. I an her favorite person. She is 100% sure that I am her mama so why did I feel like I couldn't breathe?

I did my best to hold it all in during the conversation but when it was done and over, I couldn't' even process it. I had to excuse myself and go the bathroom. I locked myself in a stall and I was brought back to my first week of residency after maternity leave. My boobs ached. I was still pumping and bringing milk back to C at the time. I was experiencing all the symptoms of post-partum depression but didn't even realize it. People asked how little C was doing and I could barely hold in the tears as the insurmountable guilt of leaving her with mom came back to me with every mention of her name. The mom guilt was so strong and with just that statement--it came all back to me.

It made me question am I bad mom? Is C going to be okay? Am I selfish for wanting a career and motherhood? I turned into that insecure first year radiology resident in the bathroom at the VA hospital with tears streaming down my face only to bite my tongue so hard as if the physical pain could take the emotional pain so I can back to fluoroscopy suite to do the next upper GI study that was on the schedule.

But I am not that little girl. I am not a part time mom. It takes a village to raise a child. Even as an attending, I have a wonderful village that includes a nanny who helps me with morning drop offs, a house cleaner, a dog walker, a grandmother who is willing to help out whenever she's needed and a wonderful husband, who despite his own busy work schedule, will watch little C in a heartbeat if he is free.

I will not apologize for my village. They make me the mom and physician I am today. I will not apologize for being a doctor. I will not apologize for being an example of what a woman can accomplish to my daughter. And most importantly, I will not let your words doubt my ability as a mom ever again.

I am more than a part time mother. I am her mother. And the only opinion that should matter is hers. And tonight before bed, I asked little C, do you wish mommy could stay home with you? She said, "no mama, I go to school because I'm a kid and you go to work to help sick people because you're a doctor."

Don't let people like him bring you down. As Taylor Swift will say, haters going to hate hate hate but I'm just going to shake, shake, shake, shake, shake I shake it off, I shake it off...

Monday, July 31, 2017

I've been following your blog for a couple of years now, and every single post has worked for me as an inspiration to stay strong and fight for what I love, medicine. But today, I have found myself in a confusing position and I really need advice on a special subject, residency application and motherhood. I'm currently an MS4, yayy!! And as application day approaches, I have been working on my personal statement however, I'm encountering that one of my biggest assets (or so I feel) is being a mother. I have been advice by all my friends at medschool to not even mention my family, husband or 2 daughters (2yrs and 5 months). According to most people having a family will make me a less reliable resident than someone without strings attached. However, this is my story:

I married after college a few months before beginning medical school, my husband and I had been accepted to the same school, and things sounded great. During the first year we adapted to the new environment, developed our studying skills and set our expectations for matching one day.

Fast forward 1 year, and baby #1 came along. She was born during our 2nd year. We managed to fix our schedules for studying around the clock and created routines that allowed us to keep up with classes/exams while taking turns to care for our daughter. No LOA requested/no gaps, we were lucky enough that our baby#1 was born right before one break so we had 2 weeks off to adapt to our new family, and organize. Somehow, we survived and made it worked. Now, let's fast forward one more year and baby#2 came along (we wanted our daughter to have company as our families live across the country). Once again, we worked our way around it. I was able to get 1 week off during one of my rotations and resume the following monday. The attending was very understanding and seem surprised to see that I had decided it to keep going and again no LOA, no excuses given.

Today when I look back, I see that everything that I have done until this day has shaped me to who I am at this point. My desire to pursue medicine, and my determination to continue has remained strong while building the family that I always dreamt of. I always thought of medicine as a career choice not a life changer. As a mother, I feel that I learnt to be more organized and time efficient, I proved myself to be dedicated and goal oriented. So far we both remained on top of our class and have shown the same commitment since day one (I say we because this took teamwork). I took my step 1 and Step 2 CK/CS while breastfeeding/pumping because I wanted to continue to care for my daughters while working really hard to accomplish my goals. I wasn't willing to stay behind. Being a mother helped me connect with patients at more than one level, becoming very understanding of their concerns. I will applying to pediatrics because not only did I mentioned it on my personal statement when I applied to medical school as I always had a passion for peds but during these 4 yrs I realized that I'm drawn toward the field naturally. So I wonder, how can I write a "personal" statement of who I really am and why if I cannot mentioned how I became me and why I think I can be a good asset? I feel that a good physician should be able to show balance and commitment while remaining human and empathetic. Us moms, do this every day at home and on the field. Some people even believe in not even mention it during interviews but to be honest I am proud of being one and hope to become a great physician one day. Please any help or guidance. I am really confused right now.

Tuesday, May 23, 2017

This is a topic that I'm sure other moms with only one kid can relate to--it's the never ending questions of why haven't you had your second child yet? It seems as if you have two children, every one assumes you're done and then if you have four, people start to question why you aren't on birth control. First of all, it's nobody business the number of children your family should have. But I feel compelled to share my thoughts so here goes.

I was beyond clueless when I got pregnant at the age of 27. I was 9 months into my internship, general surgery no less! and soon after about to start my 4 years in radiology training. At the time, my husband was in his third year of his 6 year orthopedic residency program. We were about the enter the monster of hot messes but we just had no idea. So come January 2013, 6 months into my first year of radiology residency came C. She was perfect. I was not. That is the short version of the story.

I was the epitome of hot mess. I cried a lot. My husband had to go back to work in less than week after her delivery. I was with my parents. I had help but I still couldn't get my act together. C was a good baby. She slept 3-4 hour stretches from birth. I could not sleep at all. I was overwhelmed with anxiety, guilt and basically a state of "WTF did I get myself in?" I was an emotional zombie. I was in a cycle of nursing, crying and attempting to sleep but never really getting any. It took about 4 weeks to realize that maybe I have post-partum depression.

I had all the symptoms. Feeling overwhelmed. Check. Feeling guilty. Check. Feeling empty and not bonding with baby. Check. Feeling even more guilty about that. Check. Not knowing why this is happening. Check. Check. Check

Even though, I was aware. I couldn't get myself to do anything about it. I just powered through the end of my seven week maternity leave. I went back to work. I pretended like nothing happened. But these feelings did not go away. Given the schedule of residency and the shame of postpartum depression, I did not tell anyone nor did I get the proper treatment. I went to a maternal health psychiatrist once, who talked to me after hours, off the record. She wanted to start me a low dose antidepressant but I never took it. I think these feelings never really went away. They did fade over time as I adjusted to my schedule of constantly driving back and forth between San Diego and Orange County (1 hour commute) and doing residency in between that time. I was so busy that I didn't really give myself to process my emotions. I just kept chugging along and watching C grow up was the silver lining. She transformed from this tiny infant to a toddler who was a force to be reckoned with.

When she finally moved to live with me, we encountered several other hot messes but I do believe that is what it took for me to rid of these postpartum blues. I still have the occasional feelings of working mom guilt and anxiety especially when it comes to big changes in my life (such as moving and starting my first attending job!). But I do feel "cured" but for the most part. It took time but I was finally her person. I was the one that she wanted in her time of need. I was the one that could figure out what was in that little head of hers without her saying anything. I knew then that I was definitely put on this earth to be her mom.

So yes. That is why I don't have my second child yet. I knew what triggered my postpartum depression with C. I was overwhelmed with a husband in training, my own training and my feelings of inadequacy as a mom. I told myself if and when we have another child, I will do it when I'm ready so my mental health isn't at stake.

My husband had to leave for the east coast for his fellowship training right after C moved and now he works in LA. We've done long distance for two years now. We are finally at the end of this long distance journey. I will be moving up to LA in less than 6 weeks after I complete my fellowship in breast imaging. I knew I could not handle a pregnancy, C and another baby while he was away. I learned from my first postpartum experience that a lot of my anxiety was not having my husband around. I understood why he wasn't there but it didn't change how I felt. So I knew that time was not an option for child #2.

And right now is still not a good time. My poor C has not lived with her father yet. She spent the first 7 weeks of her life with me and grandparents. She then lived until 2 and a half with her grandparents in Orange County with seeing me almost every weekend but her dad maybe twice a month. She then experienced life with me in San Diego. She suddenly had to do full time pre school, new home and a new primary care giver. She went from being the center of the universe to being a toddler of a "single" working mom in residency. She saw her dad maybe once a month while he was on the east coast. Now that I'm in fellowship and her dad is an attending in LA, she spends most weekends with both of us. She's gotten used to that now and every Sunday, she hugs her daddy and says "see you next weekend!" It breaks my heart at times that she thinks this is "normal." I want her to experience life with both parents. every single day. before we add any more changes.

So there you have it. I know I'm getting older. My ovaries may be shriveling. My uterus is crying every time I see another baby. But I am grateful for these experiences. It made me stronger in the end. It made me a better mom, wife and physician. It taught me what I needed to know to grow as a mother and maybe one day that will be a mom of two. But for now, I am perfectly content as a family of 3.

Friday, March 24, 2017

I have been tired since May 2015. I am so, so tired. But the sleep deprivation proved to be worth it today. You see, today was Match Day. The results were good. Outstanding, really. Not only did I match to my number one ranked program, but my future institution is one of the most prestigious medical centers in the world.

My journey to get today was not easy. It took me three application cycles to get accepted into medical school. The emotional toll alone of receiving dozens of rejection letters is enough to make anyone go a little crazy. But with application cycles also comes time, and as we all know, with time comes a decline in ovarian function. Women physicians are all too familiar with that line graph comparing ovarian reserve to a woman’s age. I was finally accepted into medical school at 27. By that time I was married to a man nine years my senior who was very eager to start a family. So we decided to have a baby… while I was in medical school.

After a pregnancy complicated by complete placenta previa, studying for Step 1 in the height of my third trimester, and a major placental bleed during third year orientation- my beautiful Ben was born. I have loved my son with every ounce of my being since the second I heard him cry. He has brought our family indescribable joy and not a moment goes by that I am not thankful to have him.

But being a parent is even harder than I imagined (I still have PTSD from the newborn period). Being a parent while in medical school seems like an almost insurmountable challenge. It has been exhausting and challenging and there were times I did not think I would make it to today. But today is proof. When I celebrated the news of my match, I got to share that moment with my loving husband and our smart, wild, daring, and sweet little boy.

Yes, I am still exhausted. And no, I do not believe I will get to catch up on sleep anytime soon. But just as my increasing age correlates to my declining ovarian function (that damn graph), it also represents the passage of time. My grandmother used to say that the days were long but the years were short. So to all the women who wonder if they can be a mom while in medicine... the answer is YES. Do whatever is right for you and your individual circumstance. And if you do have a baby in medical school (or at any point in your medical career), there will be times when it’s awful and times you genuinely don’t believe you can do it anymore… but it is so worth it. And whatever you do, enjoy every second because my grandmother was right. There were so many long days, but these sweet, sweet years are ever so short.

Tuesday, December 27, 2016

I am currently a MS3, married to an amazing husband for the past three years, and strongly considering pathology. We would like to have a child in my fourth year. The question for us is when to start trying and hopefully have the baby, and to maximize our chances of having the child before intern year.

Our original plan was to start trying this summer, with the hopes of having a child sometime between March and May. But I'm not sure how that would work out with having a newborn as an intern. I would really like to avoid being pregnant during my intern year (or just residency in general) as well, and so I'm also worried about the short window that gives us to try for a baby.

I do not have any familial support where I live, and I'm not considering residencies that will be near family (they live in an incredibly expensive city and have very few programs around them). Our plan for childcare is my husband quitting his job and becoming a stay-at-home dad - any money he would make by keeping his job would probably not cover the cost of daycare.

At my school, we get two months off for vacation, one of which is mandated in the winter months for interviewing. I believe I can also have two more months of light rotations as well, giving me a total of 1-3 months to spend between my interview period and infant-recovery time.

So here are my current pros and cons for having a baby earlier (Fall-Winter) vs. later (Spring).

Pros for having the baby earlier:

Will have an older infant by the time intern year starts.
May be able to avoid interviewing pregnant.
More time to get pregnant.
May be able to still use my vacation months during interview season if I have my child around that time.

Cons against having the baby earlier:

May have to interview very pregnant or be at risk of giving birth.
Will probably be very pregnant during possible audition rotations.
Will probably need to have my husband quit his job (or scale down to part time) to take care of the child while I am on rotations.
Will be taking Step II pregnant.

Pros for having the baby later:

Husband can keep his job at full time for longer, maximizing our income.
Might be able to stack my rotations so that I can have 3-4 months "off" or with light rotations to be with the baby until residency.
Avoid being pregnant while taking Step II.
Will be less pregnant during interview and possible audition rotations.

Cons against having the baby later:

Will have to interview pregnant.
Stacking my light rotations and vacation at the end of the school year may make it so I have less flexibility when interviewing for residency.
May not get pregnant in the short window we have.
Would go through intern year with a <3 br="" mon="" old.="">

I would love any feedback on my tentative plans - which of these are important vs. not so important? How difficult is it having a 3 month old vs. a 9 month old baby during intern year? - and what you would recommend for my husband and I. Thank you!

Monday, October 10, 2016

Children are expensive. So is medical school. Children take up a lot of time. So does medical school. Unfortunately time and money are two things in considerable shortage during medical training. Mixing children and medical school can be an unhappy combination. We had our baby halfway through medical school (me) and residency (the Mister). There has been lots of discussion regarding the timing of procreation in medicine (eg here and here and on this blog). My general takeaway can best be summarized with this license plate.

I have found some serious life wisdom on vehicle license plates.

My general takeaway 1.1 regarding the subject of timing babies in medical training is that there is no perfect time. Each time is good in some respect and not so great in others. Having spent my 20s in pursuits of other advanced degrees, I didn't want to wait until I had a "real doctor job". But that meant that financially it was not such a great decision. Residents stipend is not enough for supporting a family, especially when one member of said family is incurring expenses of medical school. More than a third of our income goes to childcare expenses, and that's not even including food, diapers, and a multitude of other child related expenses. We are always worried if we'll be able to pay all our bills at the end of each month. I am in debt up to my eyeballs. Financial worries are always lurking in the background of my thoughts, and money has been on my mind even more as I am looking into taking out more
loans for upcoming residency interviews.

A friend offered me wisdom from her interview experiences, telling me about some common interview questions, one of them being "Tell me about a difficult experience you had in medical school". I said (almost half jokingly), urrmm pretty much the entirety of medical school since having a baby has been one incredibly difficult experience. It is difficult to separate the experience of being a parent from that of being a medical student, and money has been one of the connecting threads between the two.

Daycare was the only affordable childcare option for us, and we are lucky to have hospital subsidized daycare. It was amusing (not really) when one of my classmates thought that "hospital subsidized" meant that all costs were covered by the hospital and it was free of charge. No, it just means there is a small discount. Though it is a "hospital affiliated daycare", but like most other daycares, it is not a 24/7 facility. Having both spouses in medical training means that both of us have very little control over our schedules. There are plenty of times that we are both working outside of daycare hours. And trainees may have an 80 hour a week work limit, but a child requires care 168 hours a week.

This same classmate who thought that daycare was free, was also
surprised to learn that I hired baby sitters to study for medical school
exams. "Wait, so every time you have to study, you have to pay someone to watch your kid? Can't you just put him in a playpen and do your studying?" Before I had a
baby, I envisioned this picture of getting home from the hospital and spending daily finite hours
of "quality time" with the little one and then he would, I don't
know, put himself to bed or maybe I'd read him a little bedtime story at the end of which he'd dutifully doze off and sleep through the night, and I'd get more hours of "quality time" studying. Or just like my classmate I assumed that I would be studying while the
baby/toddler would be happily playing by himself on the side with his toys, of
course, without interrupting me. Those fantasies/assumptions disappeared pretty fast when a real baby (who is now a toddler) showed up.

Talking to other people in our situation (two medical trainees with no family close by) most options I heard of were not financially viable alternatives for us. I have heard people say to not worry about money and keep taking out loans because when I have a "real doctor job", I'll be able to pay it all off. Maybe there is truth to that. But when I look at the enormous amount of debt that I have already accumulated, and when I think about the uncertainty with future physician compensations, I don't feel comfortable taking out loans to whatever amount.

Things haven't always worked out great with this whole arrangement. I have less than perfect grades in medical school. I feel like if it was just the hours in the hospital and then I could
come home and eat, pray, love or something, it would be fine. But because work just gets started after getting back home from work, is what makes it so hard. After a particularly rough rotation that had lots of nights and weekend shifts (read: "when daycare is not open" shifts) and an end of rotation exam, I bombed the exam. The course master told me that he was really surprised about my exam performance because the clinical portion of my grade was stellar and there was such a discrepancy between the clinical grade and the exam grade. I didn't know how to explain that for me studying for exams cost money. Whatever little savings we had, had recently disappeared after a family emergency, and as interview
expenses had drawn closer, I had scrimped on getting
sitters to study for tests.

As a minority it is sometimes difficult to explain or convince people even in the face of overwhelming evidence that social factors control how you experience your life and the color of your skin can change the opportunities and travails you encounter. At some point it is tiring to keep going through the explanations
over and over and knowing that unless someone has actually been there, they really won't know what you are talking about. I feel that way about the experience of being a mother in medicine too. I could go blue in the face with my explanations but it is exhausting.

Friday, August 5, 2016

I am three weeks into being an attending and I am writing this to all of those starting intern year (like I was when I started reading this blog), and to all of you in the middle of a long residency and questioning if you can make it through. I am writing this to put your sacrifices into perspective - all the missed recitals and mothers day lunches, the shitty clinic clothes you wear because you can't afford anything else, the many times you leave your spouse to sleep alone at night while you're on call --- I am just three weeks in, but it sure feels really worth it right now. All I feel right now is joy (Well joy and a fair amount of fear and anxiety!! but mostly joy). It feels unbelievable to finally be at this point. It has been such a long road. I know being an attending presents lots of new challenges which I am learning about every day. I know I may not feel so exuberant years from now. But right now, I'm enjoying it. I feel thankful to be in a job that I truly love, working with people I respect and feel honored to work with. I love my patients and feel energized after clinic or a day in the OR. I also feel very supported by the other faculty. I feel like that bright eyed, brand new medical student 12 years ago who wanted to "help people." Last night, after kindergarten registration, I stared at my worn out sleeping daughter and I was proud of this model of motherhood I have provided for her. I was proud of our new house, her new house, the house she will grow up in - I hope one day it will be as dear to her as the house I grew up in just 10 minutes away. My residency baby - she made me a mother in medicine. She made me a better person, a better doctor - and every moment of this struggle feels very worth it right now.

Wednesday, July 13, 2016

I had my 90-day evaluation in my new position today. I left the clinic I was working in, one overrun by burnout and toxic management, in order to remember why I went into medicine at all. I love my patients and this work, but I love my family more. I now work 3 days a week in health care administration and quality improvement. I sleep well at night now that the main cause of my insomnia has ended. My family is happier. My evaluation went very well. Immediately after my meeting, my husband reached out and said he needed to talk. I needed to talk too. He is finishing his dissertation this week, we just bought a new house, and my parents came in town for the weekend. We have been passing like ships in the night. Both busy and not really checking in enough. With moments of hugs and kisses and simple appreciation. But overall, we haven’t been checking in frequently enough and we definitely haven’t been having the weekly meetings that are my bookends at work. I feel lonely. He feels unappreciated. Why didn’t I offer to help with his appendices? Why didn’t I read the chapter he asked me to read so many months ago (honestly, he gave it to me and I forget and he never mentioned it again until today and now I feel like dirt). He feels that my work has taken priority in our family for years (medical school, residency, the toxic job took so much of our family’s energy just to stay afloat). And now I’m studying for my Boards again after I failed them last year (more about that later, I have a lot to say about it but it's so raw and traumatizing). And he’s finishing his dissertation and starting his first job as a professor at the state university.When we get busy I forget that my marriage needs check-ins, scheduled ones, on purpose because they are priorities. And when we are busy, we both have to go the extra mile to make sure that my needs, his needs, and our family’s needs are met. And I’m sitting here at work, dragging my feet because at home I am reminded of all the ways I forget. I need to go home and start remembering again. And I need to be gentle with myself because we are juggling plates and though many of them are scuffed up I pray that none of them are smashed and destroyed. I’m going to head home now in order to remember that I love him immensely. And loves me. And we can't forget.

Thursday, May 5, 2016

Do you ever feel like your life is like a TV show, but not in a good way? More like a Seinfeld kind of way, when all you can do to keep from crying is shake your head and laugh?

Episode one. I present for a labor check at 38 weeks (determined to be false labor), and find out baby boy is BREECH when at my appointment the week prior, he was firmly declared vertex! The plan is to do an external cephalic version immediately, as I am an ideal candidate. I wait nearly 11 hours, NPO, cranky, uncomfortable, and tethered to an IV pole, and at last the Ob team assembles to do the version. AS they are putting on gloves, all their pagers go off. Oh no. No. No! It’s a gyn surgical emergency, a stabbing!! A resident returns to give me the choice to wait several more hours with no guarantee of doing the version, or to schedule it for first thing the next morning. My hangry state tells me to postpone… which in retrospect is likely the wrong choice. My “false” contractions progressively and subtly transition into excruciating ones over the next 8 hours at home (I’ve lost confidence in knowing what’s real after the false alarm earlier), and at 2:30am I find myself driving alone to the hospital, jaw clenched, sobbing, and pulling over for contractions (my husband is at home with our daughter). I am 9 cm dilated - time for emergency C section - and our perfect son makes his debut with a bang thirty minutes later.

Episode two. I find out a week after our son was born that, by some miracle, I’ve received a research grant I applied for last winter. The catch? I’m required to attend the organization’s national meeting in 4 weeks to accept the award at a formal dinner. After weighing all the options, we decide to go as a family. It’s a fun city, only a 3-hour flight, expenses are partially covered, and I‘d have the opportunity to attend an awesome conference. A two year old and a 5 week old in a small hotel room together? No problem! The reality? Every day we desperately invest hours in the possibility of achieving overlapping naptime so we, too, could sleep.

Needless to say, I don’t get to attend much of the conference. I try going to talks, I really do. It’s a lot to ask my husband to watch both of them, so I go to a few presentations with the baby strapped on, hanging out by the exit door. The night of the awards ceremony finally comes. Milk pumped, baby topped off, toddler excited, husband feeling strong. But alas, this is how the evening ultimately ends.

Episode three. The number one question I’m asked during prenatal care? By multiple people at every single appointment, from 6 weeks through the bitter end? “What method of contraception do you plan to use afterwards?” This is to the point where I can only assume they think I got pregnant on accident and are doing anything possible to prevent me from letting it happen again. Every time, without fail, I say, “IUD.” Even while being prepped for my emergency CS, crying in pain, someone manages to come around and ask me if I’d like the IUD inserted... “NOT. NOW!!!” I scream. Finally, the big day comes to do my IUD insertion, at my 6-week postpartum visit (which of course requires me to bring my newborn along). When I make the appointment, they ask again if I want an IUD inserted so they can allot enough time. Mid-way through the appointment, my Ob tells me, “I’m sorry, but the administrator who gets insurance approval for IUDs is out for the morning unexpectedly, so we actually can’t do the IUD today. But don’t worry, we’ll schedule you for next week, no problem!” CUE FOREHEAD SLAP.

The stories go on and on. I will share a few more.

Feeling the sweet warmth of a blow-out spread across my sleeve as my son, who won’t nap in the crib, sleeps in the crook of my arm as I frantically try to get through the RISE exam before he wakes up (I don't stop taking the test, by the way).

Watching cake batter overflow and drip down the oven rack gratings in a million little chocolate stalactites at 4:30am while baking a birthday cake for my mother in law.

Dropping said mother-in-law off at airport. So out of it and exhausted, I accidentally drive in the buses-only lane at departures. I have never ever done this in my life. An airport official runs over and tells me to leave immediately before I get fined ($500!!) and I get out of there… but alas, a cop is waiting for me at the very end. Sigh. (But with a wailing newborn in the backseat, I fortunately get off with only a formal warning.)

We have a few warm days last week. I smell something weird. I am fearful it is something with the sump pump or crawl space (we live in a renovated brick rowhome). Long long story short, there is a dead rat in the crawl space. Yes. A. Dead. Rat. Next door had an infestation, exterminators came, rats ate poison, and one managed to get through a crumbling brick and into our crawl space. And died. No words. This is an ongoing saga. Involving the services of a mason- I never imagined I'd need a real mason, but apparently I do. But it will be ok.

And the clincher. What inspires me to sit down and write this. What drives me to actually throw my head back and laugh with tears in my eyes. Baby has his 2 month immunizations this morning, and poor thing is angry and uncomfortable… he just needs to take a nice long nap. And THIS is what I come home to- view from his window.

This is when all you can do is laugh. And be grateful for health and for even the capacity to laugh. And embrace all of this self-inflicted chaos, the q2-3 hour wake up calls that still aren't stretching out after 8 weeks, the blow-outs, projectile vomit, and laundry. So much laundry. Laugh at the fact that your parents, who had lived just an hour away, decide to move to Asia a month before baby is born, leaving you again without family support postpartum (we tell each other it's building character). Accept the frustrating feeling of hard-earned knowledge seeping out of your brain even after a few short weeks, trying to have the will-power to study and attend resident didactics and research seminars (sometimes with a sleeping newborn hidden under your jacket), but often failing. But there are some TV/movie moments. When I sink my lips into the soft pillows of my son's cheeks, also becoming aware of my daughter's pudge melting away silently. The indescribable joy of seeing our daughter transform into a sibling. When my heart explodes witnessing first smiles and giggles. The sacredness of feeling the body of such a vulnerable little human relax in your arms. Awe that I can muster up secret stores of energy and patience that are fueled only by love when I have nothing left. And awe at the magnitude of this love. So it's time to celebrate- although it hasn't been pretty, we've made it through the newborn trenches once again.

Tuesday, March 1, 2016

Our little man will hopefully make his appearance (hopefully in a much shorter and less painful way!) in the next few weeks… I hit 37 weeks a couple of days ago, and for me, this is uncharted territory as I went into labor with our daughter at 37 days on the dot. This has really felt like a milestone- as residents, we live our lives in month-long blocks, and the past two blocks have been the most intense physically and hours-wise rotations we have in our pathology program. We're all still in one piece though, and for that I am grateful. We met with our volunteer doula this past weekend, finally acquired a car seat, and took inventory of all the leftover clothes I had stashed from my daughter (mostly gender neutral, thankfully!) that we’ll be able to use again. This is finally feeling like a reality.

I wanted to share the strangest experience I had this weekend which I haven’t been able to shake. I’m sure many with multiple children relatively close together can commiserate over how different subsequent pregnancies are from the first… Beyond our work, our focus has been survival and spending as much quality time as possible with our daughter and being a family of 3. It’s been easy to forget about the pregnancy, and actually I’ve done a pretty good job at ignoring it so I don’t worry haha.. But this time, there have been no photo diaries week by week, no journal entries to my fetus, no shopping trips to buy anything special.

One experience we really treasured the first time around was going to one of those recreational 4D ultrasound places to find out the sex and see her face. We actually went twice- once around 15 weeks and once later on, maybe 25 or 26 weeks. I remember how much we stared at those photos- we even had one framed which I brought to my delivery haha. Her face was so beautiful... I still love looking at those photos in utero and seeing her face in them, her little button nose and full lips. Anyway a couple weeks ago, while feeling guilty realizing how little time was left and how little we had done, my husband and I decided to try to find a similar U/S place in the city we live in now. The place with the best reviews was far- over 30 minutes away- but we thought we owed it to our fetus to be appreciated for a morning and to let our daughter see him, haha. But it was actually disappointing… it was sort of a weird sterile office, not at all a warm fuzzy baby-friendly environment like we experienced back in California. Also, previously, we had to sign that we were receiving prenatal care and write down the name of the hospital and Ob practice in case there were any abnormalities that needed to be reported; at this place, all they took was our name and EDD. And unfortunately, our little guy was totally covering his face with both hands and feet at the session, so they invited us to come back for another look in a couple weeks.

So this weekend we went back to test our luck, and while in the waiting room, the doctor/owner of the business (radiology IMG, not practicing here; his wife seems to be the ultrasound tech) came out and asked if I could come help him with translation issues with his current Brazilian client that couldn’t speak English. He knew I had an MD, but I was caught off guard. Without thinking too hard, I shrugged and said, sure, I only had patchy Spanish and Italian to offer but maybe it could be a bridge to their Portugese. I entered the room to find a young couple with their two older sons, maybe 7 and 9. The woman looked scared. I started to feel scared. According to her LMP, she should have been around 10 weeks along. No cramping, no bleeding since. Regular periods prior. Apparently, no insurance and she hadn’t seen an Ob or PCP- only positive HPTs. The problem was that no heartbeat was detected, and she was measuring only around 5 weeks. My heart sank. It was clear they had all come to share the joyous occasion of seeing the baby for the first time as a family. I was so sad for them as I had been in the same position a year prior, the ultrasound planting the first seed in my heart of the possibility of miscarriage to follow. We tried to explain as gently as possible that time will tell whether the pregnancy will continue. But I was upset that I was in this unexpected position. I was upset that she didn’t have a doctor of her own. I was upset that she was receiving this information in this setting. I tried my best to encourage her to establish care with an Ob as soon as possible, but it seemed unlikely that it would happen.

I keep thinking about her today and wish the best. I truly hope this is a dating issue and that her pregnancy will progress. I keep thinking of my own miscarriage, the ordinariness and near universality of the experience and how isolating, unique, and devastating it still feels. I think of the miracle of our family now ready to welcome a boy just a year later. Of all the health we take for granted. I think of the fragility of our children, that this is all the beginning… by gaining so much in love we also have so much to lose. But I remind myself that the alternative, of not opening our hearts to the potential of more love and family, is also a sort of loss. I was reminded of this old song by Iris DeMent, called “Let the Mystery Be,” which expresses her coming to terms with rejecting organized religion (she grew up in a big religious family I believe) in a really beautiful way... I often sing this to myself when I feel like I need to let go and not worry... so much unexplainable mystery in life.

Here is the brief and only glimpse our little one gave us of his face in the two ultrasound sessions. He wants to stay a mystery and I accept that. I just can’t wait to kiss those chubby cheeks and lips and see what the rest of him looks like… well, maybe I can wait just a couple more weeks :)

Monday, February 8, 2016

I've been a lurker on the Mothers in Medicine blog for awhile, and let me just say, the stories and posts have been so comforting to me, especially on my tough days. I'm a third year resident, currently in my third trimester of my first pregnancy in a two-resident household. I wanted to share my pregnancy experience to see if I could gather some advice from fellow mothers in medicine. I feel quite isolated as the only resident in my male-dominated program to be a new mother/pregnant in a long time, and at a hospital system where few female residents are mothers/get pregnant during residency, in general.

My pregnancy has been hard, to say the least. I envy all of those mothers who have the pregnancy glow, who have boundless nesting energy, and who just "love being pregnant!!!" My pregnancy has not been like that. First, it was unplanned, and happened about a month after my husband and I got married. I found out the day after my 24 hour call; I was so nauseous and I was late. I took the pregnancy test two times before I could truly believe that the two lines were actually there. After I confirmed the positivity and announced the news, it seemed like everyone was happy about it, but me. I had unknowingly performed multiple fluoroscopy procedures, and I was so worried about what the effects would be on the baby. I consulted my OB, a radiation physicist, and multiple radiologists, who assured me that this early, the effects should be all or nothing, and if the baby had made it through to this point, everything should be fine. My husband and I made the decision to proceed with the pregnancy. We felt that women go through pregnancies in worse situations and conditions, and we should be so lucky to get pregnant this easily with a supportive environment there to welcome the baby when he/she arrives.

Anyway, fast forward through first trimester, which was fraught with all- day morning sickness that even lasted through my night shifts and into my second trimester, to third trimester, where I now find myself having failed the 1 hour and 3- hour glucose tolerance tests. Just barely. I'm now diagnosed with gestational diabetes, and I feel like a failure. Prior to being pregnant, I was skinny, fit, and perfectly healthy. The only risk factor I had was being Asian. The news was terrible; I had been feeling like I couldn't excel as a resident, and now, I felt like I couldn't handle my duties to be a healthy pregnant mother. As someone who has been usually been able to balance multiple plates somewhat successfully, these two losses felt like huge blows.

I've been dealing with gestational diabetes the way that I deal with most challenges in my life; through hard work. I've been increasing protein intake, decreasing carbohydrates, logging my food religiously in a diary, pricking my finger 4 times a day, and walking at least 5 miles a day. My post-prandial sugars have been great. They're super tight, and well below the cut-off of 140. In fact, I haven't had an abnormal number. On the other hand, my fasting sugars in the morning are a touch high. The cut-off is 95 at my physician's office, and mine ranges from mid eighties to mid-to-upper 90's. Actually, there have only been 3 values from 95-100. My physician has given me until Monday to get the values down, before I have to go on insulin. I've tried everything to no avail. I still have 2-3 values hovering at 96. I feel like considering these numbers high is like splitting hairs. But I think my physician disagrees.

It's not that I'm against using insulin. I'm all for using insulin... that is, if I'm truly and outrageously hyperglycemic. I've done my research (on primary literature resources) and read that physicians will use cutoffs of less than 90, 95, 100, even 105. My range is in a gray area. There's also been a paper published showing that if the pregnant woman has no risk factors (the baby is not measuring large, there's no polyhydramnios, etc.), then the physician will let the fasting glucose ride to 105 before initiating insulin. The paper showed that aggressively treating lower risk gestational diabetes women (below 105, and with normal to smaller fetuses) with insulin may be associated with restricted fetal growth. I would be considered a "lower risk" mother, as my latest ultrasound this past week showed the baby was measuring below average, and everything else was normal. I also don't want to run the risk of being hypoglycemic, which I think is a valid concern, given that I'm about to enter a much busier rotation in which it will be harder to eat, and in which, if i become hypoglycemic, would be disruptive to patient care.

Do you guys think that my hesitancy about insulin in my situation is unreasonable? How should I approach the conversation with her? Of course, if more of my numbers are abnormal, then I'll definitely initiate insulin. I already superficially brought up this concern to my OB, which is why she has let me wait until Monday. But it seems like she is pretty set on starting me on insulin that day no matter what I tell her. She dropped the cutoff, saying that normal pregnant patients' fasting blood sugars run from 70-90's, and that tight control is necessary to prevent macrosomia and to improve the baby's transition (and to lessen NICU admission). I don't want to be "that patient." But at the same time, even though this is not my field of expertise, I do have health literacy, and I don't want to act too aggressively to make an already stressful situation more stressful. I don't feel like I'm as high risk as she's making this out to be.

I really appreciate your thoughts and opinions.

By the way, I have been and will continue to work 24 hour shifts and nights into my 9 month. But that's another dilemma for another day.

Monday, February 1, 2016

I hope things get better. At least that is what I tell myself everyday as I leave my house at the crack of dawn to get to work, barely having seen my child the day before. Better I do this now than when she is older are the words of encouragement I get to help me cope with my situation. I knew from an early age that my greatest desire was to become a mom, a working mom that is, until, Miss A arrived. I received the news I was pregnant halfway through my residency interviews. Scared, upset, sad were the emotions going through my head when I found out I was pregnant as this wasn't planned. I just got married and we wanted to wait at least a year. How the heck am I going to manage beginning intern year 9 months pregnant??!!?? I dreaded telling whichever program I matched into that I would have to take maternity leave so early in the start of residency. But, I thought I could do it. I was strong enough. Fast forward almost a year later. Every day I wonder if I made the right decision to not delay starting my residency. I miss so much of her development with my crazy hours. I see all my friends who could afford to be stay at home moms and become extremely envious. How lucky are they that they can be there for their child while I'm stuck working 70+ hours. Why did I become a doctor??!! Right now I am in the midst of reapplying to a more lifestyle friendlier residency but I'm constantly wondering if it gets better. If it is worth it. If I didn't have the massive loans, I would have quit already. I never imagined how something so small could cause you to rethink you life decisions. I fear that whatever little bond we developed during my maternity leave will dissolve. That I will be viewed as a stranger. God, I miss her. I just hope it gets better.

Wednesday, December 9, 2015

1. That tired drinking out of a firehose analogy...unfortunately true. I remember being appalled when I read that med students study multiple hours a day on top of going to class. I foolishly thought on my days that end at noon (Monday and Friday) I can pick my daughter up from preschool / go to the gym / twiddle my thumbs. Instead, I am thankful for an afternoon with no class so I can hole up in the library and study. The endless studying is not death, falling behind is.

2. Wearing a half-face respirator during anatomy lab makes me look like Bane from Batman. But hey, that's a pretty good trade-off for formaldehyde-free breastmilk. And the puzzled looks I get when people see the lingering lines on my face after removing the mask -- extra giggles.

3. The lactation room is the mecca of multi-tasking. Pumping can be accomplished while eating, studying, napping, crying, making phone calls, etc. Bonus points for attempting three things at a time.

4. Whatever makes your life easier, and if you have the means, do it. Examples include ordering food, dry shampoo, a breast pump car adaptor, skipping a bath or two for the kids (hey they could have dry skin?).

5. GET YOUR CHILDCARE SITUATION FIGURED OUT AND SET (x10000000)

6. You will be older than some of the MS2s-MS4s, the same age as some residents or even attendings. Bless your eye cream and good genes, although four years of this will probably negate all of that.

7. Saying no is okay.*
"Want to study together at extremely-far-from-my-house coffee shop at extremely-inconvenient-hour?" - No.
"Want to go rage after block exam and stay out all night?" - No.
"Want to join a thousand interest groups and shadow everyone possible in the hospital?" - No...maybe second year?

8. *It is also okay to say yes.
"Need help?" - YES!

9. Your classmates will be amazing people who have done amazing things. Everyone is incredibly supportive and no one is trying to sabotage you unlike the undergrad premeds.

Wednesday, December 2, 2015

Being a father not interested in medical school makes me a somewhat non-traditional reader I imagine.

I am ultimately writing for advice. I read a number of great posts on your blog, but I am coming at this from a different direction and was hoping one of you would be able to point me in the right the right way.

My ex-wife is a brilliant woman in her Junior year of her undergrad and planning to start applying for medical schools. We have a good co-parenting arrangement and try to do our best by our three boys (4, 5 and 7). I am no longer in the medical field but do have 8 years experience as a critical care paramedic so I can appreciate both how talanted she is and how hard her road is going to be. She is going to apply locally but is also looking at the Virginia area due to family there. I am willing to consider relocation if I can find appropriate work (I work in IT in a rather specialized area).

My question is, how can I best approach the subject of custody? I don't want to take the kids away from her by any means (she is a fantastic mom!), but I am concerned that raising three young school age boys while attending medical school will be overwhelming. She can accomplish anything she sets her mind to, but even she can't accomplish *everything*.

My initial thought is to offer/ask to take the custodial role, freeing her up to apply herself 100% at school while still affording the boys a stable home life and predictability in routine. I don't know for sure how she would receive this, but suspect she would at least be willing to consider it. Then again, as a divorcee my ability to mis-read her intentions is a matter of public record. : )

There has to be a mutually beneficial way to handle this situation that benefits all of us, and I am looking for advice on where I could look for information. I have looked at some of the schools websites for information on family services offered by medical schools but it's hard to find in a lot of cases.

If you have a moment, would you be able/willing to point me in the right direction, or even offer some insight from your own experiences?

Monday, November 23, 2015

Mothers in Medicine! I am seeking your advice/expertise on the difficult subject of how to treat pregnant residents. A little background: I am a chief resident at a busy anesthesia program that takes frequent and draining 24 hour calls in the OR. Those calls are such that, most of the time, the call room is a distant fantasy. I am also a mom to an active preschooler and pregnant with #2. All was going well until after a particularly exhausting 24 hour call, when I started having frequent, regular contractions at 20 weeks. I had to take several days off work and (thankfully!) things calmed down. I'm now trying to ease myself back into the OR call rotation.

My question for all of you who have been through a resident with tough, frequent 24 hour calls or night shifts... how did your program handle pregnant residents? I've heard from friends at other programs about policies that were put in place to limit calls because so many pregnant residents were going into preterm labor. Other programs limited night shifts for the same reason. Obviously, these changes put strain on non-pregnant residents. Was there widespread resentment to enacting such restrictions?

Amazingly, I'm the first resident to be pregnant at our program in over a decade, but I know there are many women behind me hoping to do the same. I'm hoping to find some common sense changes that can be made to keep pregnant residents working, but in a safe way for mom and baby.

Sunday, August 16, 2015

So in the last two months I managed to do most of the things on my list. We moved nearly all our stuff down and unpacked while I was 37 weeks along. SK's birthday bash went smoothly. Our house is rented. Baby #2, SE arrived and is happy and healthy. We waited until she was two weeks old, packed up our remaining items in a U-haul and made the ten hour drive to our new home. (It's really only supposed to take six hours, but every 30 miles someone either needed to be fed or had to pee.) And now we are here, adjusting to life with a new family member, in a new city, with new schools and jobs. Everyone I've told about our moving experience has thought we're completely nuts, which we are, but we had a plan, stuck to it as much as we could and anything else that came up, we decided to just roll with it. In fact, these last four words have really become my motto as of late, so much so that I can basically take a picture of our crazy lives at any moment and have #justrollwithit be a fitting caption.

My first week of school was packed with such moments. No one to drop off or pick up SK from school on Monday? Just stay home with grandma and do some crafts, eat lots of treats and watch too much TV (#justrollwithit). Get to school and realize I brought my pump but forgot all my pump parts at home? Use the lactation room's backup pump and try to ignore the idea that others have used the same pump (#justrollwithit). Motion-sensor lights turn off in lactation room while pumping, leaving me fumbling around in the dark? Dance like a mad woman in the chair, still attached to my pump until the lights turn on (#justrollwithit....ok there might have been some expletives here and there).

I'm starting to realize that my med school experience is going to be a little bit different than what I had envisioned. I missed out on most of the socializing opportunities my first week because I had to run down to the first floor lactation room to pump while everyone else ate lunch. In fact, it is lunch time right now as I write this and I'm being serenaded by the gentle pff pff pff of my lovely pump. When our social calendar first came out I foolishly rsvp'd to several different events which I'm now realizing was a tad bit ambitious.I guess having a preschooler made me forget what newborn schedules are like; I forgot about the eating every 3 hours thing and the getting up multiple times at night routine. I am feeling a little bit left out, but I know the social aspect of med school will come with time, especially when the little one is a bit older. My biggest struggle right now is trying to figure out when I'm going to find time to study and I'm hoping with some trial and error I'll figure it out. Yesterday an assignment took me 5 hours...maybe 1 hour of actual work in total, 1 hour playing DJ for SK so she could perform dance routines in the living room, 30 minutes of reading Fancy Nancy books, 30 minutes of redirection, timeouts and talks, 1 hour of snuggles and cuddles, 45 minutes of breastfeeding and 15 minutes of accidental sleeping. By the time everyone else is actually in bed and I can study without distraction, I'm about to face-plant into my laptop.

I am loving what I'm learning though and I'm thankful to be in a great program. It's the logistical part that's scaring me right now. I can feel the dreaded "what have I gotten myself into" question creeping into my mind sometimes, but I'm pushing it aside for now. I'm rolling along and I'll be rolling with it for the next 4 years and probably thereafter.

Monday, August 10, 2015

Hi, I just started a 3 year residency program, and I'm feeling desperately close to quitting. In fact, if it weren't for the huge financial investment I've made up to this point, I almost certainly would have quit before I even got to this point.

I have a daughter who was born at the beginning of 4th year, and I think 4th year was probably the best year of my life. I loved spending time with her at home (despite being bored and lonely for parts of it). Now that she's older, she's even more wonderful and funny and fascinating, which I didn't think was possible. I dreaded the start of residency, which was, unfortunately, a black cloud over that otherwise wonderful year.

Now that it's here, I don't know whether it's worth it to continue. I don't find the work difficult or all that unenjoyable; I kind of like it and I definitely like the idea of contributing to our family financially. I feel like I could surely handle it all if I didn't have a child. I grieve every single day the lost time with her and the opportunity to watch her grow and be there for her babyhood, which is so fleeting and the part of my own life I want to experience more than anything. Add to this some chronic health problems that I am dealing with, and I feel so depressed. And of course there's no time to seek out treatment or professional help. I really have nobody to talk to about it. I feel like I'm drowning.

I have a supportive non-medical spouse who has a good job, though it would still be a blow of course to give up a future physician income. And I do have some loans, though well below the national average. So...I guess I'm looking for advice. Do I stay or do I go? Or should I approach my PD about some sort of part-time compromise (guessing that's a huge long shot). If I somehow make it though, and don't destroy all relationships in the process, my husband and daughter would probably be better off long term. If I go, I can start to recuperate some sense of sanity and mental and physical health, and I think it's better for me personally. Maybe I could convince myself it's better for my daughter since she'll be in a less stressful environment. I feel lost. -J

Monday, August 3, 2015

2 weeks into attendingdom, I am starting to realize how life has changed fundamentally. Gone are the days of working 75 hours a week. Gone are the days of calculating TPN and anion gap. Gone are the days of being questioned about details that you struggle to remember and know you’ll never need again outside of residency. I now work 4 days a week and can pick up a weekend day if I want to. We haven’t had an office emergency that I have managed yet, but I’ve got emergent management for the 15 or so minutes until EMS arrives down. I’ve got that!

In spite of my nice schedule and awesome colleagues, I realize that it will take a while to let go of my resident mindset. During residency, a resident-mommy-friend and I would chat and comment about how guilty we felt missing out on things. Not being able to care for a sick child. Not being able to make it to bedtime. Missing out on weekend fun. And I realize now that although I won’t be able to always take off to care for my sick child, I have more flexibility to. I now can make it to bedtime every day of the week. And other than my one Saturday a month, I’ll be around for the weekend fun.

Last week on my off day (every Friday), I attended Zo’s first summer camp performance and the joy on his face when he saw me cheering in the front row was priceless. It’s taking my breath away now to remember it. I took him home early, we played at the playground and then went home for family dinner time. I am at a coffee shop now writing this post before restarting a timed section of the 2014 Prep pediatric board questions. This week, I got to attend his second performance and it was just as cute. This week I was strong enough to let him stay for a few more hours while I study (last week I just couldn’t - since in the old days I very rarely could pick him up early).

I want to be able to enjoy every little bit. I want to be a present parent. I want to be a present provider. And I am (for the most part, I was kind of late for his performance today, but I just had to do 5 more questions and get that samosa from the local shop)! After so many years of waiting to “get there”, it’s here and it’s mine and I’m committed. Next time they ask who wants to work overtime I think I’ll pass and stay at home to snuggle with my family. Here’s to enjoying the little bits, the fundamental shifts, and this new phase in life. Question 151 here I come.

Thursday, July 30, 2015

I'm a 4th year medical student with young kids wondering how others carve out time to study in residency? Of course I'm sure I'll be learning quite a bit "on the job," but I'm certain I'll still need to be learning and studying more outside the hospital as well.

I recently finished my MS3 year and was able to have a strong performance on the wards and shelf exams this year because my husband was a rock star; there were so many times that I stayed at the hospital after a 12 hr day studying and he put the kiddos to bed on his own. I also got babysitters on the weekends before exams so he wasn't doing everything on his own. And of course I carried around study materials and studied whenever I could like when I was waiting to pick up my kids from activities. I'm just curious what other solutions people have come up with. I don't want my husband to feel like a single dad forever; needless to say 3rd year was tough for him because he also works full-time. My youngest (and last!) will be 2.5 years old when I start residency and my older children will be in elementary school. I'm going into anesthesiology.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

Disclaimer

No content of this blog should be taken as medical advice. Any references to patients have been altered to maintain confidentiality. Content and links on personal blogs listed on the blogroll are not vetted or monitored and do not represent endorsements by Mothers in Medicine.